Skip to main content

Prehospital Telemedicine and EMS Integration

  • Chapter
  • First Online:
Telemedicine in the ICU

Abstract

Prehospital medicine is rapidly evolving in both scope and purpose with telemedicine providing novel opportunities to offer support and oversight to emergency medical service providers while bringing advanced care to the site of illness or injury. In this chapter, the history, development, and sustainability of prehospital telemedicine programs are discussed while highlighting past, current, and possible future applications. The challenges associated with expanding prehospital telemedicine and the need to address them with innovative funding models, stakeholder buy-in, and a thorough understanding of varying local prehospital systems and their interplay with existing regulatory frameworks are also discussed. This chapter will provide a framework for understanding the complex and evolving nature of prehospital telemedicine in a practical context. Growth in this field is rapid, so this chapter looks to encourage further expansion of programs by highlighting current successful programs. This includes mobile telestroke with the development of mobile stroke units, community paramedicine, emergency department avoidance, and specialty interfacility transport.

The authors would like to thank J. Aaron Matthews, MSN, RN, CEN, for his significant contributions to the development of this publication.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. 114th United States Congress. Fixing America’s Surface Transportation Act, An Act to authorize funds for Federal-aid highways, highway safety programs, and transit programs, and for other purposes Pub.L. 2015:114–94.

    Google Scholar 

  2. Altman L. Johnson gets digitalis after second heart attack to pump enough blood. New York Times. 1972:20.

    Google Scholar 

  3. American College of Emergency Physicians. The role of the Physician Medical Director in emergency medical services leadership. Ann Emerg Med. 2018;71:e39–40.

    Article  Google Scholar 

  4. Barrett KM, Pizzi MA, Kesari V, TerKonda SP, Mauricio EA, Silvers SM, Habash R, Brown BL, Tawk RG, Meschia JF, Wharen R, Freeman WD. Ambulance-based assessment of NIH stroke scale with telemedicine: a feasibility pilot study. J Telemed Telecare. 2017;23:476–83. https://doi.org/10.1177/1357633X16648490.

    Article  PubMed  Google Scholar 

  5. Belt GH, Felberg RA, Rubin J, Halperin JJ. In-transit telemedicine speeds ischemic stroke treatment: preliminary results. Stroke. 2016;47:2413–5.

    Article  Google Scholar 

  6. Berger E. Physician burnout. Ann Emerg Med. 2013;61:A17–9. https://doi.org/10.1016/j.annemergmed.2013.01.001.

    Article  Google Scholar 

  7. Bergrath S, Reich A, Rossaint R, Rörtgen D, Gerber J, Fischermann H, Beckers SK, Brokmann JC, Schulz JB, Leber C, Fitzner C, Skorning M. Feasibility of prehospital teleconsultation in acute stroke – a pilot study in clinical routine. 2012;7:1–9.

    Google Scholar 

  8. Beume L, Hieber M, Kaller CP, Nitschke K, Bardutzky J, Urbach H, Weiller C, Rijntjes M. Large vessel occlusion in acute stroke cortical symptoms are more sensitive prehospital indicators than motor deficits. Stroke. 2018;49:2323–9.

    Article  Google Scholar 

  9. Bijen N, Sidney S, Liebeskind DS, Bruce O, Doojin K, Nerses S, Latisha A, Brian B, Pablo V, Fernando V, Gary D, Reza J, Saver JL. A brief prehospital stroke severity scale identifies ischemic stroke patients harboring persisting large arterial occlusions. Stroke. 2008;39:2264–7. https://doi.org/10.1161/STROKEAHA.107.508127.

    Article  Google Scholar 

  10. Bowry R, Parker S, Wu T, Noser E, Jackson K, Rajan SS, Yamal J, Persse D, Richardson L, Grotta JC. Benefits of stroke treatment using a Mobile stroke unit compared with standard management the BEST-MSU study run-in phase. Stroke. 2015;46:3370–4.

    Article  CAS  Google Scholar 

  11. Brandler E, Gropen TI, Janjua N, Levine SR, Poleshuck R, Spencer J, Gokaldas R, Szarek M, Brandler ES. Factors related to the sensitivity of emergency medical service impression of stroke. Prehosp Emerg Care. 2014;18:387–92.

    Article  Google Scholar 

  12. Bukata R. Are Mobile CT Stroke Units Worth the Price Tag?. Emergency Physician’s Monthly: 10/31/2018. 2017.

    Google Scholar 

  13. California Health and Safety Code. DIVISION 2.5. EMERGENCY MEDICAL SERVICES [1797–1799.207] (Division 2.5 added by Stats. 1980, Ch. 1260.) CHAPTER 9. Liability Limitation [1799.100–1799.112]. 1980.

    Google Scholar 

  14. California Telehealth Resource Center. The CTRC Telehealth Program Developer Kit, A Roadmap for Successful Telehealth Program Development. 2014.

    Google Scholar 

  15. Centers for Medicare and Medicaid Services. Medicare Physician Fee Schedule CY 2019 CMS-1693-P. 2019.

    Google Scholar 

  16. Chellappa DK, DeCherrie LV, Escobar C, Gregoriou D, Munjal KG. Supporting the on-call primary care physician with community paramedicine. Intern Med J. 2018;48:1261–4.

    Article  Google Scholar 

  17. Clark W, Chiota-McCollum NA, Cote J, Schneider BJ, Pitchford H, Gunnell BS, Lindbeck GM, Perina DG, O’Connor Robert E, Chapman Smith S, Solenski NJ, Worrall BB, Southerland AM. Abstract TP246: Emergency Medical Services Survey of a Low-cost, Ambulance-based System for Mobile Neurological Assessment: The iTREAT Study. Stroke. 2016;48:ATP246. https://doi.org/10.1161/str.48.suppl_1.tp246.

    Article  Google Scholar 

  18. Cone D, Brown LH, Greenberg B, Richards ME, Hubble MW, Cone DC, Millin MG, Schwartz B, Patterson PD. Paramedic determinations of medical necessity: a meta-analysis. Prehosp Emerg Care. 2009;13:516–27.

    Article  Google Scholar 

  19. Cone DC, Brice JH, Delbridge TR, Myers JB, Ebook Central – Academic Complete, Wiley Online Library UBCM All Obooks. Medical oversight of EMS systems in: Anonymous emergency medical services: clinical practice and systems oversight. 2nd ed. Chichester/Hoboken: Wiley; 2015 Bass RR, Lawner B, Lee D, Nable JV. Medical oversight of EMS systems. In: Cone DC, Brice JH, Delbridge TR, Myers JB, editors. Emergency medical services: clinical practice and systems oversight; (2015). https://doi.org/10.1002/9781118990810.ch82.

  20. Crampton RS, Aldrich RF, Gascho JA, Miles JR Jr, Stillerman R. Reduction of prehospital, ambulance and community coronary death rates by the community-wide emergency cardiac care system. Am J Med. 1975;58:151–65. https://doi.org/10.1016/0002-9343(75)90564-1.

    Article  CAS  PubMed  Google Scholar 

  21. Delaware Code TITLE 16 Health and Safety CHAPTER 68. EXEMPTIONS FROM CIVIL LIABILITY Subchapter I. Immunity for Rendering Emergency Care § 6801 Persons rendering emergency care exempt from liability.

    Google Scholar 

  22. Donnan G, Bastianello S, Buchan A, Bladin C, D’este C, Attia J, Davis S, Parsons M, Hankey G, Vanhooren G, LEYS D, Kaste M, Lees KR, Bluhmki E, Von Kummer R, Brott TG, Toni D, Grotta JC, Albers GW, Hamilton SA, Marler JR, Tilley BC, Davis SM, Donnan GA, Hacke W. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010;375:1695–703.

    Article  Google Scholar 

  23. Espinoza AV, Van Hooff R, De Smedt A, Moens M, Yperzeele L, Nieboer K, Hubloue I, De Keyser J, Convents A, Tellez HF, Dupont A, Putman K, Brouns R. Development and pilot testing of 24/7 in-ambulance telemedicine for acute stroke: prehospital stroke study at the Universitair Ziekenhuis Brussel-project. Cerebrovasc Dis. 2016;42:15–22.

    Article  Google Scholar 

  24. Federal Communications Commission. Carr Announces $100 million ‘Connected Care Pilot Program’. 2018.

    Google Scholar 

  25. Federal Communications Commission. The FCC’s 5G FAST Plan. 2018. https://www.fcc.gov/document/fccs-5g-fast-plan. Accessed 1 Nov 2018.

  26. Fiebach JB, Grittner U, Ebinger M, Winter B, Wendt M, Weber JE, Waldschmidt C, Rozanski M, Kunz A, Koch P, Endres M, Audebert HJ, Gierhake D, Villringer K, Kellner PA, Hartmann A, Mackert B. Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke a randomized clinical trial. JAMA. 2014;311:1622–31.

    Article  Google Scholar 

  27. Gaston SR. Accidental death and disability: the neglected disease of modern society. A progress report. J Trauma Acute Care Surg. 1971;11:195–206.

    Article  CAS  Google Scholar 

  28. Glenn M, Zoph O, Jenkins K, Fisher J, Weidenaar K, Barraza L, Greco W, Paode P. State regulation of community paramedicine programs: a national analysis. Prehosp Emerg Care. 2018;22:244–51.

    Article  Google Scholar 

  29. Gonzalez M, Alqusairi D, Jackson A, Champagne T, Langabeer J II, Persse D. Houston EMS advances mobile integrated healthcare through the ETHAN program. JEMS. 2015;40:11. Accessed 6 Feb 2019.

    Google Scholar 

  30. National Association of Emergency Medical Technicians. Second mobile integrated healthcare and community paramedicine national survey report. 2018;13

    Google Scholar 

  31. Hindmand R, Maggiore AW. Medical control of emergency medical services. J Health Life Sci Am Health Lawyers Assoc. 2011;4:65–94.

    Google Scholar 

  32. Holland C. Reality Plus Drama Equals “EMERGENCY!”. Smithsonian Institute’s The National Museum of American History. 2015. http://americanhistory.si.edu/blog/reality-plus-drama-equals-emergency. Accessed 08/2018.

  33. Howard J, Jensen AM, Ence T, Contreras L, Dunford J. 326 Mobile integrated telehealth: a feasibility study with community paramedicine providers and frequent 911 users. Ann Emerg Med. 2017;70:S129.

    Article  Google Scholar 

  34. Hudson R (2017) H.R.304 – Protecting Patient Access to Emergency Medications Act of 2017.

    Google Scholar 

  35. Itrat A, Taqui A, Cerejo R, Briggs F, Cho S, Organek N, Reimer AP, Winners S, Rasmussen P, Hussain MS, Uchino K, Tre CPAS. Telemedicine in prehospital stroke evaluation and thrombolysis taking stroke treatment to the doorstep. 2016;73:162–8.

    Google Scholar 

  36. McCloskey KA, King WD, Byron L. Pediatric critical care transport: is a physician always needed on the team? Ann Emerg Med. 1989;18:247–9.

    Article  CAS  Google Scholar 

  37. Katz BS, McMullan JT, Sucharew H, Adeoye O, Broderick JP. Design and validation of a prehospital scale to predict stroke severity Cincinnati prehospital stroke severity scale. Stroke. 2015;46:1508–12.

    Article  Google Scholar 

  38. Kawaguchi A, Nielsen CC, Saunders LD, Yasui Y, De Caen A. Outcomes/predictions: impact of physician-less pediatric critical care transport: making a decision on team composition. J Crit Care. 2018;45:209–14.

    Article  Google Scholar 

  39. Kreofsky BLH, Blegen RN, Lokken TG, Kapraun SM, Bushman MS, Demaerschalk BM. Sustainable telemedicine: designing and building infrastructure to support a comprehensive telemedicine practice. Telemed J E Health. 2018. https://doi.org/10.1089/tmj.2017.0291.

  40. Kunz A, Ebinger M, Geisler F, Rozanski M, Waldschmidt C, Weber JE, Wendt M, Winter B, Zieschang K, Fiebach JB, Villringer K, Erdur H, Scheitz JF, Tütüncü S, Bollweg K, Grittner U, Kaczmarek S, Endres M, Nolte CH, Audebert HJ. Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study. 2016;15:1035–43.

    Google Scholar 

  41. LaMonte MP, Cullen J, Gagliano DM, Gunawardane R, Hu P, Mackenzie C, Xiao Y. TeleBAT: mobile telemedicine for the Brain Attack Team. J Stroke Cerebrovasc Dis. 2000;9:128–35.

    Article  CAS  Google Scholar 

  42. LaMonte MP, Xiao Y, Hu PF, Gagliano DM, Bahouth MN, Gunawardane RD, MacKenzie CF, Gaasch WR, Cullen J. Shortening time to stroke treatment using ambulance telemedicine: TeleBAT. J Stroke Cerebrovasc Dis. 2004;13:148–54.

    Article  Google Scholar 

  43. Langabeer I, James R, DelliFraine J, Fowler R, Jollis JG, Stuart L, Segrest W, Griffin R, Koenig W, Moyer P, Henry TD. Selected topics: prehospital care: emergency medical services as a strategy for improving ST-elevation myocardial infarction system treatment times. J Emerg Med. 2014;46:355–62.

    Article  Google Scholar 

  44. Langabeer JR 2nd, Gonzalez M, Alqusairi D, Champagne-Langabeer T, Jackson A, Mikhail J, Persse D. Telehealth-enabled emergency medical services program reduces ambulance transport to urban emergency departments. West J Emerg Med. 2016;17:713–20. https://doi.org/10.5811/westjem.2016.8.30660.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Lewis B. Hendricks regional launches telestroke program. Inside Indiana Business Online Video Article. 2017.

    Google Scholar 

  46. Lima FO, Silva GS, Furie KL, Frankel MR, Lev MH, Camargo ECS, Haussen DC, Singhal AB, Koroshetz WJ, Smith WS, Nogueira RG. Field assessment stroke triage for emergency destination a simple and accurate prehospital scale to detect large vessel occlusion strokes. Stroke. 2016;47:1997–2002.

    Article  Google Scholar 

  47. Liman TG, Winter B, Waldschmidt C, Zerbe N, Hufnagl P, Audebert HJ, Endres M. Telestroke ambulances in prehospital stroke management concept and pilot feasibility study. Stroke. 2012;43:2086–90.

    Article  Google Scholar 

  48. Lippman JM, Cote J, Solenski NJ, Worrall BB, Southerland AM, Smith SNC, McMurry TL, Sutton ZG, Gunnell BS, Cattell-Gordon DC, Rheuban KS, Perina DG. Mobile Telestroke During Ambulance Transport Is Feasible in a Rural EMS Setting: The iTREAT Study. 2016;22:507–13.

    Google Scholar 

  49. Madiraju SK, Genuit T, Catino J, Kokaram C, Bukur M. In by helicopter out by cab: the financial cost of aeromedical Overtriage of trauma patients. J Surg Res. 2017;218:261–70.

    Article  Google Scholar 

  50. Mallery S. Beyond Seinfeld’s Good Samaritan Debacle: Protecting Citizens Who Render Care at the Scene of an Accident From Civil Liability. 2010;41:647–54.

    Google Scholar 

  51. Maurer D. Yesteryears: part 1: Lyndon Johnson’s 1972 visit to Charlottesville brought unexpected drama. The Daily Progress. 2014.

    Google Scholar 

  52. McNamara MJ, Oser C, Gohdes D, Fogle CC, Dietrich DW, Burnett A, Okon N, Russell JA, DeTienne J, Harwell TS, Helgerson SD. Stroke knowledge among urban and frontier first responders and emergency medical technicians in Montana. 2008;24:189–93.

    Google Scholar 

  53. Meadows-Pitt M, Fields W. Research: the impact of prehospital 12-Lead electrocardiograms on door-to-balloon time in patients with ST-elevation myocardial infarction. J Emerg Nurs. 2014;40:e63–8.

    Article  Google Scholar 

  54. Moore C, Weaver MD. Medical necessity in emergency medical services transports. Am J Med Qual. 2012;27:250–5.

    Article  Google Scholar 

  55. Mort A, Eadie L, Regan L, Macaden A, Heaney D, Bouamrane M, Rushworth G, Wilson P. Combining transcranial ultrasound with intelligent communication methods to enhance the remote assessment and management of stroke patients: framework for a technology demonstrator. Health Informatics J. 2016;22:691–701. https://doi.org/10.1177/1460458215580353.

    Article  PubMed  Google Scholar 

  56. Munjal KG, Shastry S, Loo GT, Reid D, Grudzen C, Shah MN, Chapin HH, First B, Sirirungruang S, Alpert E, Chason K, Richardson LD. Patient perspectives on EMS alternate destination models. Prehosp Emerg Care. 2016;20:705–11. https://doi.org/10.1080/10903127.2016.1182604.

    Article  PubMed  Google Scholar 

  57. National Association of EMS Physicians/American College of Emergency Physicians. Position paper: National Association of EMS physicians: alternate ambulance transportation and destination. National Association of EMS Physicians/American College of Emergency Physicians Joint Position Paper. 2001;5:289–289.

    Google Scholar 

  58. National Association of EMS Physicians/National Registry of Emergency Medical Technicians. Clinical Credentialing of EMS Providers. Prehosp Emerg Care. 2017;21:397–8.

    Google Scholar 

  59. National Highway Traffic Safety Administration. DOT HS 810 657 National EMS Scope of Practice Model. p. 31. 2007.

    Google Scholar 

  60. National Public Safety Telecommunications Council National Association of State Emergency Medical Services Officials Emergency Medical Services Communications Working Group. EMS telemedicine report prehospital use of video technologies final report. 2016.

    Google Scholar 

  61. National Registry of Emergency Medical Technicians The NREMT Certification Eligibility, Discipline and Appeals Policy. 2018

    Google Scholar 

  62. Ohio Administrative Code. 4765-3-05 Medical director requirements for each emergency medical services organization. 2014.

    Google Scholar 

  63. Pennsylvania Code § 1023.1. EMS agency medical director.

    Google Scholar 

  64. Pérez de la Ossa N, Carrera D, Gorchs M, Querol M, Millán M, Gomis M, Dorado L, López-Cancio E, Hernández-Pérez M, Chicharro V, Escalada X, Jiménez X, Dávalos A. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. STROKE. 2014;45:87–91.

    Article  Google Scholar 

  65. Rudd M, Buck D, Ford G, Price C. A systematic review of stroke recognition instruments in hospital and prehospital settings. Emerg Med J. 2016;33:818.

    Article  Google Scholar 

  66. Ryb GE, Cooper C, Waak SM. Delayed trauma team activation: patient characteristics and outcomes. J Trauma Acute Care Surg. 2012;73:695–8.

    Article  Google Scholar 

  67. Saver J, Schwamm L, Hernandez AF, Smith E, Lin CB, Peterson ED, Liang L, Xian Y, Olson DM, Shah BR, Smith EE, Saver JL, Schwamm LH, Fonarow GC. Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke. Circ Cardiovasc Qual Outcomes. 2012;5:514–22.

    Article  Google Scholar 

  68. Sawyer NT, Coburn JD. Community paramedicine: 911 alternative destinations are a patient safety issue. West J Emerg Med. 2017;18:219–21.

    Article  Google Scholar 

  69. Schwamm LH, Holloway RG, Amarenco P, Audebert HJ, Bakas T, Chumbler NR, Handschu R, Jauch EC, Knight WA IV, Levine SR, Mayberg M, Meyer BC, Meyers PM, Skalabrin E, Wechsler LR, Council AHAS, Peripher IC. A review of the evidence for the use of telemedicine within stroke systems of care a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2009;40:2616–34.

    Article  Google Scholar 

  70. Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: a systematic review. J Telemed Telecare. 2018;24:4–12. https://doi.org/10.1177/1357633X16674087.

    Article  PubMed  Google Scholar 

  71. Sequeira D, Martin-Gill C, Guyette FX, Kesinger MR, Thompson LR, Jovin TG, Massaro LM. Characterizing strokes and stroke mimics transported by helicopter emergency medical services. Prehosp Emerg Care. 2016;20:723–8.

    Article  Google Scholar 

  72. Singh JM, MacDonald RD, Ahghari M. Emergency medical services/original research: critical events during land-based interfacility transport. Ann Emerg Med. 2014;64:9–15.

    Article  Google Scholar 

  73. Shelton SL, Swor RA, Domeier RM, Lucas R. Position paper. Medical direction of interfacility transports. Prehosp Emerg Care. 2000;4:361–4.

    Article  CAS  Google Scholar 

  74. Smith SNC, Brown PC, Waits KH, Wong JS, Bhatti MS, Toqeer Q, Ricks JV, Stockner ML, Habtamu T, Seelam J, Britt RC, Giovia JM, Blankson BK, Bennam P, Gormley MA, Lu J, Ornato JP. Development and evaluation of a user-centered mobile telestroke platform. Telemed J E Health. 2018; https://doi.org/10.1089/tmj.2018.0044.

  75. Smith SNC, Padrick MM, Lippman JM, Mehndiratta P, Chee CY, Solenski NJ, Worrall BB, Southerland AM, McMurry TL, Perina DG, Gunnell BS, Cattell-Gordon DC, Govindarajan P, Resler BL, Keenan K, Cahill EA, Dietiker C, Smith WS. A low-cost, tablet-based option for prehospital neurologic assessment: The iTREAT Study. Neurology. 2016;87:19–26.

    Article  Google Scholar 

  76. Southerland AM, Brandler ES. The cost-efficiency of mobile stroke units where the rubber meets the road. Neurology. 2017;88:1300–1.

    Article  Google Scholar 

  77. State of Virginia 12VAC5-31-590. Operational Medical Director Requirement.

    Google Scholar 

  78. Stroud M, Moss M. Tele-transport: combining mobile patient assessment with critical care outside tertiary care centers. Pediatrics. 2017;140:1.. (abstract).

    Article  Google Scholar 

  79. Swickard S, Winkelman C, Hustey FM, Kerr M, Reimer AP. Original research: patient safety events during critical care transport. Air Med J. 2018;37:253–8.

    Article  Google Scholar 

  80. Teleb MS, Hage AV, Carter J, Jayaraman MV, McTaggart RA. Stroke vision, aphasia, neglect (van) assessment – a novel emergent large vessel occlusion screening tool: pilot study and comparison with current clinical severity indices. 2017;9:122–6.

    Google Scholar 

  81. Thomas SH, Blumen I. Review: helicopter emergency medical services literature 2014 to 2016: lessons and perspectives, Part 2—nontrauma transports and general issues. Air Med J. 2018;37:126–30.

    Article  Google Scholar 

  82. Uhley HN. Electrocardiographic telemetry from ambulances. A practical approach to Mobile coronary care units. Am Heart J. 1970;80:838–42.

    Article  CAS  Google Scholar 

  83. United States Department of Transportation, National Highway Traffic Safety Administration. 2011 EMS System Demographics, The 2011 National EMS Assessment DOT HS. 2014;811:723.

    Google Scholar 

  84. University of California Los Angeles, Center for Prehospital Care What’s the Difference Between an EMT and a Paramedic? https://www.cpc.mednet.ucla.edu/node/27. Accessed 09/08=1 2018.

  85. Virginia Administrative Code. 12VAC5-31-1810. Qualifications for EMS Physician Endorsement. 2012;29(01).

    Google Scholar 

  86. Virginia Department of Health. Virginia Certification Program Outlines. 2018. http://www.vdh.virginia.gov/emergency-medical-services/virginia-certification-program-outlines/. Accessed 09/01 2018.

  87. Walter S, Kostpopoulos P, Haass A, Helwig S, Keller I, Licina T, Schlechtriemen T, Roth C, Papanagiotou P, Zimmer A, Vierra J, Körner H, Schmidt K, Romann M, Alexandrou M, Yilmaz U, Grunwald I, Kubulus D, Lesmeister M, Ziegeler S. Bringing the hospital to the patient: first treatment of stroke patients at the emergency site. PLOS One. 2010;5:1–5.

    Article  Google Scholar 

  88. Ward NS, Afessa B, Kleinpell R, Tisherman S, Ries M, Howell M, Halpern N, Kahn J, Members of Society of Critical Care Medicine Taskforce on ICU Staffing. Intensivist/patient ratios in closed ICUs: a statement from the Society of Critical Care Medicine Taskforce on ICU Staffing. Crit Care Med. 2013;41:638–45. https://doi.org/10.1097/CCM.0b013e3182741478.

    Article  PubMed  Google Scholar 

  89. White R, Wingrove G. Principles for Community Paramedicine Programs: a joint position statement of the National Association of EMS Physicians and the National Rural Health Association. p. 4. 2012.

    Google Scholar 

  90. Wu T, Nguyen C, Ankrom C, Yang J, Persse D, Vahidy F, Grotta JC, Savitz SI. Prehospital utility of rapid stroke evaluation using in-ambulance telemedicine: a pilot feasibility study. Stroke. 2014;45:2342–7. https://doi.org/10.1161/STROKEAHA.114.005193.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  91. Wu T, Parker SA, Jagolino A, Yamal J, Bowry R, Thomas A, Yu A, Grotta JC. Telemedicine can replace the neurologist on a Mobile stroke unit. Stroke. 2017;48:493–6.

    Article  Google Scholar 

  92. Yokley R, Sutherland R. Radio equipment. In: Anonymous emergency!: Behind the Scene, Jones & Bartlett Learning. 2007. p. 116–118.

    Google Scholar 

  93. Yperzeele L, Van Hooff R, De Smedt A, Valenzuela Espinoza A, Van Dyck R, Van de Casseye R, Convents A, Hubloue I, Lauwaert D, De Keyser J, Brouns R. Feasibility of AmbulanCe-Based Telemedicine (FACT) Study: safety, Feasibility and Reliability of Third Generation in-Ambulance Telemedicine. PLOS One. 2014;9:1–9.

    Article  Google Scholar 

  94. Pitchford HM. Early BioPhone, Charlottesville BioPhone found among a collection of other historical items contained at the Charlottesville Albemarle Rescue Squad. 2018.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew M. Southerland .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pitchford, H.M., Divers, M.C., Chapman, S.N., Southerland, A.M. (2019). Prehospital Telemedicine and EMS Integration. In: Koenig, M. (eds) Telemedicine in the ICU. Springer, Cham. https://doi.org/10.1007/978-3-030-11569-2_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-11569-2_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-11568-5

  • Online ISBN: 978-3-030-11569-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics